Choose Your Own Adventure: Psychiatric Advanced Directives Coming Soon to an ED Near You


West Florida


Oak Hill Hospital

Document Type


Publication Date



Mental health directive, mental health proxy, psychiatric advanced directive, psychiatric care instructions


Emergency Medicine | Psychiatry | Psychiatry and Psychology


Psychiatric advanced directives (PADs) are utilized by mental health patients to direct their psychiatric care including assigning surrogates for medical decision-making, listing preferred inpatient psychiatric/treating facilities, preferred medication regimens to stabilize acute psychiatric condition and to facilitate the patient's overall interaction with the mental health system. This article reviews the rationale behind PADs, how they can be utilized to reduce the need for de-escalation techniques, restraints and chemical anxiolysis by partnering with patients in the delivery of their care. This paper will also briefly address some of the practical limitations that Emergency Physicians and allied health care providers might face in attempting to honor PADs including the inability to admit to preferred facilities due to staff shortages or other issues associated with the global COVID-19 pandemic.

Publisher or Conference

International Journal of Academic Medicine